These last few days have been filled with contradictions.

My friend, Elyn Saks, the author of The Center Cannot Hold: My Journey Through Madness, has done us a huge favor by publishing an excellent article in The New York Times.

THIRTY years ago, I was given a diagnosis of schizophrenia. My prognosis was “grave”: I would never live independently, hold a job, find a loving partner, get married. My home would be a board-and-care facility, my days spent watching TV in a day room with other people debilitated by mental illness. I would work at menial jobs when my symptoms were quiet. Following my last psychiatric hospitalization at the age of 28, I was encouraged by a doctor to work as a cashier making change. If I could handle that, I was told, we would reassess my ability to hold a more demanding position, perhaps even something full-time.

Then I made a decision. I would write the narrative of my life. Today I am a chaired professor at the University of Southern California Gould School of Law. I have an adjunct appointment in the department of psychiatry at the medical school of the University of California, San Diego, and am on the faculty of the New Center for Psychoanalysis. The MacArthur Foundation gave me a genius grant.

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Those of you who are regular readers know that I believe one person who speaks out and advocates can make a difference in a community. This blog post, published in February 2010, is a reminder of how our words can prompt change — sometimes without us even knowing it.

Watching the inaugural celebration yesterday brought back memories of another presidential swearing in. I was a young reporter at The Washington Post when President Ronald Reagan took his first oath of office in January 1981. Along with another reporter, I was assigned to write a front page story about the throngs of spectators who had come to celebrate. The big political coverage was left to the paper’s heavy-weights,  David Broder, Hayes Johnson, Helen Dewar, and Lou Cannon. I was excited to be part of the team that was covering a historical event and producing a commemorative issue.

I had not way of knowing then — as I walked through the crowds — of  how Reagan would impact our mental health system.

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When I posted this blog in May 2010 there were an estimated 350,000 persons with mental illnesses, such as bipolar disorder and schizophrenia, in American jails and prisons. Incredibly, that number has nearly doubled now, with an estimated half million behind bars. The creation of Mental Health Courts, Intercept Programs, Jail Diversion and Re-Entry Programs has helped slow the tide, but our jails and prisons are still filling up with persons whose only real crime is that they became ill. 

The first time I went into a prison as a reporter was in the mid- 1970s when I worked at the now closed Tulsa Tribune.  The city editor, Windsor Ridenour, assigned me to cover a meeting at the Oklahoma State Penitentiary where the pardon and parole board was convening to decide who would remain behind bars and who would be freed.

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My friend, Dr. Tracey Skale, the chief medical director at the Greater Cincinnati Behavioral Health Services, was  interviewed by a local television channel in Cincinnati about violence and mental health services. I’ve been traveling for several days and only now was able to watch the half-hour interview on NEWSMAKERS .  Dr. Skale made several key points:

1. While the majority of persons with mental illnesses are not dangerous, those with severe mental disorders who are untreated, are more likely to commit violent acts than the general population.

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The preliminary hearing this week for James Eagan Holmes, the alleged shooter who murdered 12 and injured 58 during a July 20, 2012, rampage in an Aurora, Colorado movie theater, is once again raising questions about the insanity defense.
I suspect that the public often doesn’t understand a key point in insanity cases. The determining factor is not whether a person has a mental disorder or even the severity of his illness. It is whether his mental illness prevented him from being able to tell the difference between right and wrong.

Here’s my view on why that’s a poor standard.

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